德国常规婴儿4CMenB疫苗接种预防B群侵袭性脑膜炎球菌病的公共卫生影响及成本效益分析
Public Health Impact and Cost-Effectiveness Analysis of Routine Infant 4CMenB Vaccination in Germany to Prevent Serogroup B Invasive Meningococcal Disease.
作者信息
Scholz Stefan, Schwarz Magdalena, Beck Ekkehard, Meszaros Kinga, Schneider Melanie, Ultsch Bernhard, Greiner Wolfgang
机构信息
Bielefeld University, Bielefeld, Germany.
GSK, Prinzregentenplatz 9, 81675, Munich, Germany.
出版信息
Infect Dis Ther. 2022 Feb;11(1):367-387. doi: 10.1007/s40121-021-00573-w. Epub 2021 Dec 7.
INTRODUCTION
Invasive meningococcal disease (IMD) is an uncommon, severe, life-threatening disease primarily affecting infants, with potential lifelong sequelae. Neisseria meningitidis (Nm) serogroup B (MenB) causes most IMD cases in Germany, many of which can be prevented with four-component MenB (4CMenB) vaccination. The potential public health and economic impact of introducing routine 4CMenB infant vaccination in Germany was assessed.
METHODS
A dynamic transmission-based cost-effectiveness model adapted for Germany assessed the impact of infant 4CMenB universal mass vaccination (UMV) versus no vaccination. The model included the latest real-world evidence on vaccine effectiveness, the comprehensive burden of disease on patients (sequelae) and their family (quality of life impact), comprehensive German IMD costs, and vaccination uptake assumptions.
RESULTS
The largest public health impact was predicted in children: a rapid decline, 5 years after UMV implementation, of 39.9% (34.7%) for MenB (all IMD) cases aged 0-4 years and 42.4% (36.8%) in infants. Over lifetime (100-year time horizon), 4CMenB could prevent 3154 MenB (3303 all IMD) cases, 291 MenB (304 all IMD) deaths and 1370 MenB (1435 all IMD) long-term sequelae. 4CMenB saved 25,878 quality-adjusted life-years (QALYs), at a cost of €188,762 per QALY gained in the base case (societal perspective including lost productivity). Scenarios including potential Nm carriage protection (enabling herd protection) or societal preferences for the prevention of severe diseases led to more cost-effective results, while a scenario excluding IMD impact beyond the patient with increased discounting of vaccination health benefits produced less cost-effective results.
CONCLUSIONS
MenB IMD is a vaccine-preventable disease. This analysis for Germany can inform decision-makers on the potential impact of introducing infant 4CMenB UMV. The program is predicted to rapidly produce health benefits (reduction in child cases, deaths and sequelae) at a cost per QALY to society of around €190,000 (base case), decreasing to around €78,000 when considering societal preferences and IMD underreporting.
引言
侵袭性脑膜炎球菌病（IMD）是一种罕见、严重且危及生命的疾病，主要影响婴儿，可能会导致终身后遗症。B 群脑膜炎奈瑟菌（Nm）导致德国大多数 IMD 病例，其中许多病例可通过四价 B 群脑膜炎球菌结合疫苗（4CMenB）预防。本研究评估了在德国引入常规 4CMenB 婴儿疫苗接种对公共卫生和经济的潜在影响。
方法
一个基于传播动力学的成本效益模型，适用于德国，评估了婴儿 4CMenB 普遍大规模接种（UMV）与不接种疫苗的影响。该模型纳入了关于疫苗有效性的最新实际证据、疾病对患者（后遗症）及其家庭的综合负担（生活质量影响）、德国 IMD 的综合成本以及疫苗接种率假设。
结果
预计对儿童的公共卫生影响最大：在实施 UMV 5 年后，0 - 4 岁 B 群脑膜炎球菌（所有 IMD）病例迅速下降 39.9%（34.7%），婴儿中下降 42.4%（36.8%）。在整个生命周期（长达 100 年）内，4CMenB 可预防 3154 例 B 群脑膜炎球菌（3303 例所有 IMD）病例、291 例 B 群脑膜炎球菌（304 例所有 IMD）死亡以及 1370 例 B 群脑膜炎球菌（1435 例所有 IMD）长期后遗症。4CMenB 节省了 25,878 个质量调整生命年（QALY），在基础案例中（从社会角度包括生产力损失）每获得一个 QALY 的成本为 188,762 欧元。包括潜在的 Nm 携带保护（实现群体保护）或社会对预防严重疾病的偏好的情景导致更具成本效益的结果，而一个排除了患者之外的 IMD 影响并增加了疫苗接种健康效益贴现率的情景产生了成本效益较低的结果。
结论
B 群脑膜炎球菌 IMD 是一种可通过疫苗预防的疾病。这项针对德国进行的分析可为决策者提供有关引入婴儿 4CMenB UMV 的潜在影响的信息。预计该计划将迅速产生健康效益（减少儿童病例、死亡和后遗症），社会每获得一个 QALY 的成本约为 190,000 欧元（基础案例），考虑到社会偏好和 IMD 报告不足时降至约 78,000 欧元。
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